Variation in haemodynamic monitoring for major surgery in European nations: secondary analysis of the EuSOS dataset

Tahania Ahmad; Christian M Beilstein; Cesar Aldecoa; Rui P Moreno; Zsolt Molnár; Vesna Novak-Jankovic; Christoph K Hofer; Michael Sander; Andrew Rhodes; Rupert M Pearse

doi:10.1186/s13741-015-0018-8

Variation in haemodynamic monitoring for major surgery in European nations: secondary analysis of the EuSOS dataset

Perioper Med (Lond). 2015 Sep 23:4:8. doi: 10.1186/s13741-015-0018-8. eCollection 2015.

Authors

Affiliations

¹ Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
² Hospital Universitario Rio Hortega, Valladolid, Spain.
³ Unidade de Cuidados Intensivos Neurocríticos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
⁴ University of Szeged, Szeged, Hungary.
⁵ Ljubljana University Medical Centre, Ljubljana, Slovenia.
⁶ Triemli City Hospital of Zurich, Zurich, Switzerland.
⁷ Charité University, Berlin, Germany.
⁸ St. George's University of London, London, UK.
⁹ Adult Critical Care Unit, Royal London Hospital, London, E1 1BB UK.

^# Contributed equally.

Abstract

Background: The use of cardiac output monitoring may improve patient outcomes after major surgery. However, little is known about the use of this technology across nations.

Methods: This is a secondary analysis of a previously published observational study. Patients aged 16 years and over undergoing major non-cardiac surgery in a 7-day period in April 2011 were included into this analysis. The objective is to describe prevalence and type of cardiac output monitoring used in major surgery in Europe.

Results: Included in the analysis were 12,170 patients from the surgical services of 426 hospitals in 28 European nations. One thousand four hundred and sixteen patients (11.6 %) were exposed to cardiac output monitoring, and 2343 patients (19.3 %) received a central venous catheter. Patients with higher American Society of Anesthesiologists (ASA) scores were more frequently exposed to cardiac output monitoring (ASA I and II, 643 patients [8.6 %]; ASA III-V, 768 patients [16.2 %]; p < 0.01) and central venous catheter (ASA I and II, 874 patients [11.8 %]; ASA III-V, 1463 patients [30.9 %]; p < 0.01). In elective surgery, 990 patients (10.8 %) were exposed to cardiac output monitoring, in urgent surgery 252 patients (11.7 %) and in emergency surgery 173 patients (19.8 %). A central venous catheter was used in 1514 patients (16.6 %) undergoing elective, in 480 patients (22.2 %) undergoing urgent and in 349 patients (39.9 %) undergoing emergency surgery. Nine hundred sixty patients (7.9 %) were monitored using arterial waveform analysis, 238 patients (2.0 %) using oesophageal Doppler ultrasound, 55 patients (0.5 %) using a pulmonary artery catheter and 44 patients (2.0 %) using other technologies. Across nations, cardiac output monitoring use varied from 0.0 % (0/249 patients) to 27.5 % (19/69 patients), whilst central venous catheter use varied from 5.6 % (7/125 patients) to 43.2 % (16/37 patients).

Conclusions: One in ten patients undergoing major surgery is exposed to cardiac output monitoring whilst one in five receives a central venous catheter. The use of both technologies varies widely across Europe.

Trial registration: ClinicalTrials.gov Identifier: NCT01203605. Date of registration: 15.09.2010.

Keywords: Cardiac output monitoring; Haemodynamic monitoring; Major surgery; Perioperative medicine.

Associated data

ClinicalTrials.gov/NCT01203605

Abstract

Associated data

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